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Study Type - Therapy (case series). 4. What's known on the subject? and What does the study add? Bilateral nerve-sparing radical prostatectomy still represents an issue for urologists as the indications to perform it depend oft from the personal clinical experience. Moreover, until now data concerning bilateral and unilateral laparoscopic nerve-sparing radical prostatectomy have been limited. This study states that bilateral laparoscopic intrafascial nerve-sparing technique results in superior functional outcomes when compared with unilateral nsLRP and it suggests to prefer a bilateral nerve-sparing technique in younger patients with low-risk, organ-confined prostate cancer.To evaluate the surgical and functional outcomes in bilateral and unilateral nerve-sparing laparoscopic radical prostatectomy (nsLRP).Between January 2005 and May 2009, 457 nsLRP were performed at our clinic. In all, 250 patients underwent a bilateral nsLRP and 207 patients underwent an unilateral nsLRP. One surgeon performed all the operations. All patients presented at biopsy a localized prostate cancer. Demographic data and perioperative and postoperative measurements and outcomes were compared.The operative times for bilateral nsLRP and unilateral nsLRP were 165 ± 45 min and 130 ± 25 min, respectively. The mean intra-operative blood loss was 450 ± 300 mL and 270 ± 160 mL in the bilateral and unilateral nsLRP groups with a transfusion rate of 3% and 1%, respectively (P = 0.013). Conversion to open surgery was never deemed necessary. Postoperatively, the mean Gleason Score after nsLRP and distribution of tumour stages was similar in the two groups, and the frequency of positive margins in both groups did not present any statistically significant difference. At 12 months, a complete continence was reported in 97% of patients who underwent a bilateral nsLRP and in 88% of patients of the unilateral nsLRP group. At that time, 69% in the bilateral nsLRP and 43% in the unilateral nsLRP groups reported the ability to engage in sexual intercourse.The bilateral laparoscopic intrafascial nerve-sparing technique results in superior functional outcomes with regard to urinary continence and sexual potency, when compared with unilateral nsLRP, reporting similar oncological outcomes.

Neutrophil gelatinase-associated lipocalin (NGAL) is a 25 kDa protein with roles in iron trafficking as well as in carcinogenesis and progression of several human neoplasias. Although the renal proximal tubule represents a major source of NGAL synthesis under various injurious stimuli to the kidney, NGAL expression has been rarely evaluated in renal tumors up to now. In view of this, in the present study we analyzed the expression of this protein in renal tumors of different histotype and grade so as to evaluate whether a role for NGAL might be also proposed in the carcinogenesis of these neoplasms. NGAL immunoexpression was analyzed in 30 surgically resected renal tumors [18 clear cell, 5 papillary and 3 chromophobe renal cell carcinomas (RCCs), 2 urothelial carcinomas and 2 oncocytomas] and in the peritoneal metastasis of a clear cell RCC. A variable NGAL immunoexpression was found in 28/30 cases. High NGAL expression was significantly associated with the papillary and chromphobe histotypes (P=0.016) and with a higher histological grade of clear cell and papillary RCC (P=0.004). Moreover, NGAL expression was retained in the peritoneal metastasis of clear cell RCC. Our findings demonstrate that NGAL is expressed in several histotypes of renal tumors. Its highest expression in the papillary and chromophobe histotypes might be related to a higher need in iron uptake, which could be exploited in anti-cancer therapies with iron chelators against these neoplasias. Further studies are required to investigate the potential diagnostic utility of NGAL in the early diagnosis of metastatic progression of RCC.

Prostate cancer (caP) is a major public health problem. Many groups have attempted to identify prognostic risk factors to early detect caP and to identify who will need active treatment. Since the introduction of prostate specific antigen (PSA), diagnosis of caP has increased even as mortality for prostatic cancer has declined. Using current recommended guidelines, the PSA test suffers from both of limited specificity and sensitivity. With the aim to improve early detection of prostatic cancer the volume adjusted PSA, PSA isoforms and PSA kinetics have been investigated. Recently, technological advances in molecular assays have led to the discovery of new markers with high specificity. Further, proteomic array profiling and DNA methylation assays could provide for more accurate diagnosis and prognosis. Current evidence suggests that no single marker is likely to achieve the desired level of diagnostic and prognostic accuracy: future research should focus on validation of already existing biomarkers and the discovery of new markers to identify men with aggressive prostate cancer and to predict outcomes after therapies.

A 58-yr-old woman was referred to our hospital for hematuria and a painless, rapidly growing abdominal mass. Computed tomography showed a rounded mass, 23 × 19 cm in diameter, spread over the left retroperitoneal space. A thrombus was observed occupying the left renal vein until the vena cava. Total left nephrectomy with excision of the retroperitoneal mass was carried out. A cavotomy highlighted the intraluminal thrombus, which was easily detached with a forced Valsalva maneuver. The pathologic examination demonstrated a well-differentiated liposarcoma of the renal capsule with fat thrombus in the vena cava. At 24 mo follow-up, there was no evidence of recurrence.

The purpose of this report is to provide students with techniques in writing a clear and accurate undergraduate thesis proposal. Students commonly encounter a variety of problems in starting to write their thesis from conceptualization of their research questions, to selecting group mates, and ultimately starting to write the manuscript. To deal with these problems, students need effective preparations both psychological and technical for writing the thesis manuscript. Preparing oneself psychologically to write a thesis is an important consideration for students. This psychological preparation involves the use of effective cognitive strategies such as self-regulation. On the other hand, the preparedness in the technical writing of one’s thesis is emphasized in this workshop. Clarifications on how to arrive with research questions and the purpose of the literature review is presented. The functions in arriving with quality literature review are explained as a key in writing effectively other parts of the thesis proposal.

The study tested two models on the interaction of teacher variables using Structural Equations Modeling (SEM). In the first model, the effect of teacher's personality characteristics and teaching efficacy on teacher's performance and effective teaching was tested. In the second model, the effects of learner-centered practices on teacher's performance, effective teaching, and teaching efficacy were included. 296 teachers from a community college were assessed by their students on their teaching performance using the Student Instructional Report (SIR), the Effective Teaching Inventory (ETI), and the Learner-centered Practices Questionnaire which were devised by the researchers. On the other hand, the teachers assessed themselves using Osgood's Personality Characteristics Scale and the Teacher Efficacy Inventory by Gibson and Dembo (1984). In the SEM analysis, the two models did not change on their measures of goodness of fit with a RMSEA of .045 indicating that both models have a rather good fit. It was found that the teachers practicing learner-centered approaches use their self-efficacy in order to be effective in teaching, but it was also found that being effective does not result in high teaching performance ratings. The use of learner-centered practices is seen as effective but does not warrant having high ratings based on student assessment.

To evaluate the efficacy and safety of transurethral ethanol ablation of the prostate (TEAP) for patients with symptomatic benign prostatic hyperplasia (BPH) and high-risk comorbidities.Thirty-six patients (mean age 77.3 years) with symptomatic BPH or persistent urinary retention were assessed at baseline and at 3, 6, and 12 months after treatment. All patients were affected by comorbidities (cardiovascular, respiratory, hematologic, neoplastic, dysmetabolic diseases, or coagulation disorders). Baseline evaluation was achieved by the International Prostate Symptom Score (IPSS) and quality of life (QoL) score, prostate-specific antigen (PSA), prostate transrectal ultrasound (TRUS), and the maximum peak flow rate with evaluation of post-voiding residual urine volume (PVR). Treatment was performed by injecting dehydrated ethanol at a rate correlated to prostate volume into the prostate. The primary end-point for response wasor = 80% improvement of the maximum peak flow rate and significant reduction of the PVR; secondary end-points included symptom improvement (or = 40% reduction in IPSS and QoL scores). Statistical analysis was carried out with Pearson's Chi-square test and the non-parametric Wilcoxon test with an assigned statistical significance at P0.05.During the active follow-up period, we observed a statistically significant decrease of the baseline at the end of the study in the total IPSS score and in the QoL score. The mean peak flow rate improved from 6.0 +/- 2.40 ml/min to 15.2 +/- 0.14 ml/min (P0.001), while the PVR decreased from a baseline value of 290.6 +/- 14.14 ml to 4.2 +/- 14.10 ml (P0.001).We found that TEAP is a safe minimally invasive treatment, which significantly improves voiding dysfunctions in patients with symptomatic BPH.

A endocardite em válvula de Eustáquio é uma condição rara, que ocorre geralmente em usuários de drogas injetáveis e em portadores de marcapasso ou cateter venoso central. Apresentamos um caso de paciente que, em pós-operatório de cirurgia de revascularização do miocárdio com circulação extracorpórea, apresentou endocardite em válvula de Eustáquio diagnosticada pela ecocardiografia, sendo identificada Klebsiella pneumoniae à hemocultura. O paciente foi tratado com antibioticoterapia apropriada, apresentando resolução do quadro em quatro semanas. Eustachian valve endocarditis is a rare condition that affects mostly injectable drug users and patients using pacemakers or central venous catheter. We describe the case of a patient who underwent myocardial revascularization with extracorporeal circulation and who presented Eustachian valve endocarditis in the postoperative period, diagnosed by echocardiogram. The blood culture identified Klebsiella pneumoniae. He received appropriate antibiotic therapy and presented resolution of the condition within four weeks.

A endocardite em válvula de Eustáquio é uma condição rara, que ocorre geralmente em usuários de drogas injetáveis e em portadores de marcapasso ou cateter venoso central. Apresentamos um caso de paciente que, em pós-operatório de cirurgia de revascularização do miocárdio com circulação extracorpórea, apresentou endocardite em válvula de Eustáquio diagnosticada pela ecocardiografia, sendo identificada Klebsiella pneumoniae à hemocultura. O paciente foi tratado com antibioticoterapia apropriada, apresentando resolução do quadro em quatro semanas.Eustachian valve endocarditis is a rare condition that affects mostly injectable drug users and patients using pacemakers or central venous catheter. We describe the case of a patient who underwent myocardial revascularization with extracorporeal circulation and who presented Eustachian valve endocarditis in the postoperative period, diagnosed by echocardiogram. The blood culture identified Klebsiella pneumoniae. He received appropriate antibiotic therapy and presented resolution of the condition within four weeks.

To prospectively compare contrast material-enhanced ultrasonography (US) with computed tomography (CT) in the classification of complex cystic renal masses with the Bosniak system.Ethics committee approval and written informed consent were obtained. Forty patients (17 women, 23 men; age range, 31-77 years) with 44 complex cystic renal masses detected with conventional US were prospectively examined by using second-harmonic US with a second-generation contrast agent and multiphasic helical CT. Thirty-six patients had one lesion, and four patients had two lesions. Surgical resection in nine patients and imaging follow-up in 31 patients were used to determine the outcome.On contrast-enhanced US images, masses were classified as Bosniak category II (n = 18), IIF (ie, lesions were classified as category II and follow-up was needed) (n = 16), III (n = 7), or IV (n = 3) lesions. On CT images, masses were classified as Bosniak category II (n = 24), IIF (n = 10), III (n = 7), or IV (n = 3) lesions. Interobserver agreement was high (kappa = 0.86, P.001) for classification with US. Complete concordance between the readers was found for classification with CT. Complete concordance between contrast-enhanced US and CT was observed in the differentiation of surgical and nonsurgical complex cysts. Complete concordance among the three readers in the assessment of vascularity with contrast-enhanced US was found. Interobserver agreement in the evaluation of enhancement on CT images was high (kappa = 0.88, P.001). Concordance between contrast-enhanced US and CT in the evaluation of vascularization was high (kappa = 0.77, P.001).The study data suggest that contrast-enhanced second-harmonic US is appropriate for renal cyst classification with the Bosniak system.

Objective: To assess the proportion of patients with Peyronie’s Disease (PD) and the possible association with its potential risk factors in the general population of the central and western Sicily in our weekly andrological outpatient clinic. Materials and methods: We recruited a sample of 279 consecutive patients consulting our andrological outpatient clinic. Two arms were created: the first one composed by PD patients (men with symptoms suggestive for PD), the second one composed by patients with other andrological diseases (control arm). For each patient we evaluated the age, cigarette smoking, diabetes, blood hypertension and erectile function. In the PD arm we administered validated questionnaires to determine the erectile function status by the International Index of Erectile Function 5 (IIEF-5) and the pain status during erection by the Visual Analogue Scale (VAS). A univariate analysis was conducted using R software. Results: We enrolled 279 consecutive patients. The number of PD patients was 97 (34,7%). The univariate analysis showed a correlation between PD and cigarette smoking (p = 0.0242), blood hypertension (p < 0.001), erectile dysfunction (p < 0.001). No significant association was observed between diabetes and PD (p = 0.358). The median age of PD arm was 60 years and the median age of the control arm was 63,5 years; therefore the median age of PD arm resulted lower than the median age of the control arm (p = 0,031). Conclusions: Peyronie’s disease is more common than we might think; furthermore it can be diagnosed among young patients. According to our results, cigarette smoking and blood hypertension may be considered statically significant risk factors for developing PD. On the contrary diabetes seems not to be a risk factor for PD. According to our results PD should be sought also in young patients. Further studies are necessary to confirm that removing the indicated risk factors may reduce the incidence of PD.

Ultrasonography was used on 15 patients with clinical suspicion of urethral stenosis documented by retrograde urethrography. With respect to site, length and number of the stenoses, ultrasound gave the same results as the technique using contrast, with the advantage of not exposing the gonads to radiation. It also provided further data on the degree of infiltration of the spongeous body, which is a decisive factor in choosing the most rational therapeutic option and to predict recurrence.

Eustachian valve endocarditis is a rare condition that affects mostly injectable drug users and patients using pacemakers or central venous catheter. We describe the case of a patient who underwent myocardial revascularization with extracorporeal circulation and who presented Eustachian valve endocarditis in the postoperative period, diagnosed by echocardiogram. The blood culture identified Klebsiella pneumoniae. He received appropriate antibiotic therapy and presented resolution of the condition within four weeks.

"Se presenta una evaluación de diferentes propuestas para reducir la cantidad de cálculos en el análisis por computadora de modelos tridimensionales de edificios por torsión sísmica estática. Fundamentalmente, se busca reducir lo laborioso del proceso del análisis realizado con programas de cómputo al incluir la excentricidad accidental. Se describen las bases teóricas que dan origen al análisis por torsión sísmica estática de estructuras de edificios, se estudian propuestas recientes enfocadas a realizar este análisis mediante el uso de programas comerciales de análisis estructural, y se propone y evalúa un nuevo procedimiento que, sin perder precisión en los cálculos, simplifica notablemente este tipo de análisis. Se presentan ejemplos en los que se aplican las diferentes propuestas hechas y se discuten sus ventajas y desventajas."

Purpose To determine whether magnetic resonance urography (MRU), obtained before helical computed tomography (CT) in patients with acute renal colic, can help delimit the obstructed area to be subsequently examined by a targeted CT scan, thus reducing the dose of radiation. Materials and Methods Patients (51) with symptoms of acute renal colic underwent MRU and a total urinary tract helical CT. CT images from the 5 cm below the level of ureteral obstruction as demonstrated by MRU were selected out. Combined interpretation of MRU and selected CT images constituted protocol A. Protocol B consisted of the entire unenhanced helical CT of the urinary tract. The two protocols were compared regarding the following points: 1) sensitivity in diagnosing the presence of obstructing urinary stones, and 2) the delivered radiation dose. Results Protocol A and protocol B had, respectively, 98% and 100% sensitivity in demonstrating ureteral stone as a cause of renal colic. Estimated average dose calculated from phantom study was 0.52 mSv for protocol A and 2.83 mSv for protocol B. Therefore, the effective radiation dose was 5.4 times lower in protocol A compared to protocol B. Conclusion Combined MRU and short helical CT has a high sensitivity in detecting ureteral calculi with a reduced radiation dose. J. Magn. Reson. Imaging 2004;20:264–271. © 2004 Wiley-Liss, Inc.

Cystic disease (CD) is a parasitic infestation by Echinococcus granulosus and occurs endemically in many countries, associated with sheep farming. Renal involvement is rare (2-4%) and is often indicative of disseminated disease. Echinococcal larvae can reach the kidneys through the bloodstream or lymph glands or through a direct route. The larvae grow slowly, and patients bearing larvae are typically asymptomatic. We report the case of a 79-year-old male with an isolated hydatid cyst in the kidney and describe its management by transperitoneal nephrectomy. Diagnosis was based on epidemiology and imaging findings, and was confirmed by histopathological and serum examinations.

Eustachian valve endocarditis is a rare condition that affects mostly injectable drug users and patients using pacemakers or central venous catheter. We describe the case of a patient who underwent myocardial revascularization with extracorporeal circulation and who presented Eustachian valve endocarditis in the postoperative period, diagnosed by echocardiogram. The blood culture identified Klebsiella pneumoniae. He received appropriate antibiotic therapy and presented resolution of the condition within four weeks.

The relations among school ability, self-efficacy, learning approach, and metacognition were examined in a path model. Questionnaires measuring these constructs were administered to 194 Filipino college students. Path analysis was used to determine the effects of school ability on self-efficacy and learning approaches, and in turn, the effects of self-efficacy and learning approach on metacognition. The path model tested showed adequate goodness of fit ( 2 /df=2.77, GFI=.98, AGFI=.92, RMSEA=.05). In previous studies, deep approach but not surface approach to learning facilitates performance as outcome variable. However, a different pattern emerged in the results of the present study. When school ability was used as a predictor, surface approach increased and deep approach decreased as outcomes. When they were used as predictors together with self-efficacy, both increased the use of metacognition. Surface approach among Asians is seen as a useful approach to learning that is facilitated by prior school ability, and results to awareness of one’s learning. Further implications on surface and deep approach to learning are discussed.

The present study investigated the contribution of epistemological beliefs about learning and Asian values on pre-service teachers’ value for education. The relationship of epistemological beliefs and valuing education is based on Schwartz and Bilsky’s (1987; 1990) theory of human values. The participants were 362 pre-service teachers from different universities in Manila, Philippines. It was found in a standard regression analysis that both complexity and structured belief about learning significantly predicted valuing one’s education. Higher expectation for achievement, filial piety, and emotional restraint were also significant. A hierarchical multiple regression was used to test the order of contribution of Asian values (filial piety, hierarchical family structure, collectivism, emotional restraint, perseverance and hard work, higher expectation for achievement, respect for authority, and respect for education) on valuing education. The results showed that the order of Asian values based on the theory of Schwartz and Bardi (2001) significantly explained the variation on valuing education (Adjusted R 2 =.35). The contribution of each Asian value increased the variation on valuing education but it remained stable with the inclusion of respect for education and respect for authority.

Dothistroma septosporum (Gremmen & Morelet) is an economically important fungal disease that affects needles of conifers, in particular pines. Nowadays, over 60 tree species have been reported to be susceptible to infection, among them Pinus nigra (Arn.), P. brutia (Ten.), P. pinaster (Ait.), P. pinea (L.), P. mugo (Tur.) and P. sylvestris (L.) are the most susceptible in Europe. The discovery of dothistroma needle blight (DNB) dates from 1933 in Spain, 1971 in Slovenia, 1980 in Greece, 1985 in Scotland, 1986 in Serbia, 1995 in Poland, 1996 in Slovakia, 1999 in Czech Republic, 2002 in Lithuania, 2006 in Estonia, 2007 in Finland and Sweden, 2008 in Latvia and Russia, 2009 in Norway. Recently, some data of newly infected Larix spp., Abies spp. and Picea spp. by Dothistroma sp. have been reported from Lithuania, Latvia, Serbia and Macedonia. The exact origin of the disease is unknown, although it is suggested that it might be originated from the pine forests in Nepal, India and Pakistan, or also from the high altitude rain forests in South America. It is believed that the disease has been prevalent in the southern hemisphere before reaching high levels of infection in the northern hemisphere, with unprecedented records of the disease in Asia, Europe and the UK. In general, the spores of Dothistroma spread initially in moist conditions (through mist and rain), or by direct contact with other infected needles. Once the needles have been exposed to spores, the fungus germinates in wet conditions, followed by needle penetration through stomata. The optimal germination temperature is 12–18°C, with high level of humidity. The needles soon turn to reddish discoloration and on their the pathogen produces eventually the pycnidia, which are the pathogen’s fruiting body. The pycnidia are formed in the spring and early summer, and usually coincide with high level of precipitations.

Never before in the history, the invasion of the alien pest had been so numerous, causing important finan-cial losses, and at the same time EU countries had faced the lack of efficient tools to control them. The concern of public health became an urgent issue, livelihoods of growers are threatened, and export markets exposed at high risk, if policies for mitigating the pest impact are not being urgently modernized. Nowadays, these prob-lems are increasing because the ability of exotic species to invade virtually all regions of the word has been ac-celerated by global climate change, increased interna-tional travel, and on-going difficulties of detection in early invasion stages. Consequently, invasive pest and pathogen problems have not only begun to place grow -ers and commodity exporters in many countries at great financial risk, but have also stretched to the limits the capabilities of regional, national and international regu-latory agencies for dealing with them.Because of the ever-increasing numbers of in -sect pests that are invading importing and exporting countries throughout the word, a three-day mini-symposium and workshop entitled “Opportunities for enhancement of integrated pest management” were held in April 1–3, 2014 at Warsaw University of Life Sciences (SGGW), involving 45 prominent entomolo -gists, plant pathologists, invasion biologists, and pol -icy advisers. Among different topics of a symposium, the induced plant resistance, functional biodiversity, the role of ecological infrastructures and invasive (al -ien) pests and natural enemies, as well as perspectives and bottlenecks in manipulation of insect behaviour for enhancement of integrated pest management (IPM) were discussed. The workshop dealt with implication of biodiversity in genetically modified plants, and with on-farm behaviour of European cherry fly (